Fruit juices historically have been popular beverages for adult consumption. In addition to their palatability, fruit juices are considered to have nutritional value due to their content of vitamins, minerals, antioxidants and other components. One drawback to fruit juices, however, is their high content of sugar and calories. For example, despite its high sugar content, orange juice typically has been considered one of the most beneficial fruit juices and has been popular for its taste and texture. However, orange juice consumption has been declining in the United States by about 4% annually since 2004, due to a popular trend of reduced carbohydrate diets. The high sugar content of fruit juices also has caused health professionals to discourage their use in the maintenance of hydration or in oral rehydration therapy.
Oral rehydration therapy (ORT) involves the administration of an oral rehydration solution (ORS) containing glucose and sodium in water. It is estimated that over one million lives are saved each year due to the use of ORT, primarily in developing countries. An ORS provides rapid, effective hydration because sodium ion absorption in the intestines causes water molecules associated with the sodium ion to be absorbed as well. This sodium absorption is activated by glucose. Thus, water can be absorbed more rapidly from an ORS containing both sodium and glucose than from water alone. An ORS can be used to treat acute infectious diarrhea and/or vomiting, to treat hyponatremia or hypohydration due to exercise or changes in altitude, and to maintain a healthy level of hydration.
An ORS is an aqueous liquid containing from 35 to 90 milliequivalents per Liter (meq/L) of sodium (Na+) and from 1.2 to 3.0 weight percent (wt %) of a glucose containing saccharide, and having a total osmolarity of from 200 to 311 meq/L. The glucose containing saccharide may be glucose (i.e. dextrose), or a saccharide that can be hydrolyzed to form a composition containing glucose. An ORS may also include potassium, chloride, and citrate and/or bicarbonate.
The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) have recommended two ORS formulas. The initial formula has a glucose concentration of 111 meq/L, a sodium concentration of 90 meq/L, and a total osmolarity of 311 meq/L. The most recent formula has a glucose concentration of 75 meq/L, a sodium concentration of 75 meq/L, and a total osmolarity of 245 meq/L. Since the osmolarity of normal blood plasma is 275 to 295 meq/L, the latter formula is referred to as “hypoosmolar.”
In addition, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has recommended a hypoosmolar ORS formula for European children that has a glucose concentration of from 74 to 111 meq/L, a sodium concentration of 60 meq/L, and a total osmolarity of from 200 to 250 meq/L. One version of the ESPGHAN formula has a glucose concentration of 89 meq/L, a sodium concentration of 60 meq/L, and a total osmolarity of 240 meq/L. The WHO and ESPGHAN formulas are listed in Table 1.
TABLE 1ORS Formulations Recommended by Health ProfessionalsGrams per 1 Liter ORSWHOWHOaHypoosmolara,bESPGHANa,cGlucose, anhydrous20.013.516.0NaCl3.52.61.0KCl1.51.51.5Sodium citrate, dihydrate2.92.92.9Osmolarity (meq/L)311245240a“Managing Acute Gastroenteritis Among Children”, Morbidity and Mortality Weekly Report - Recommendations and Reports, John M. Ward, ed., vol. 52, RR-16, cover and p. 12.bhttp://rehydrate.org/solutions/packaged.htmc“Recommendations for Composition of Oral Rehydration Solutions for the Children of Europe - Report of an ESPGAN Working Group” J. Pediatr. Gastroenterol. Nutr., 14: 113-115, 1992.
A number of beverages are available in the United States that are marketed as providing hydration. These beverages include Pedialyte®, Rehydralyte®, and EquaLyte® (Abbott Laboratories; Abbott Park, Ill.); Enfalyte® (Mead Johnson & Company; Evansville, Ind.); CeraLyte® (Cera Products, Inc., Columbia, Md.); and Liquilytes® (Gerber Products Company; Parsippany, N.J.). The available formulas for these products are listed in Table 2.
TABLE 2ORS Formulationsa,d,eCarbohydrateSodiumPotassiumChlorideCitrateOsmolarity(grams/L)(meq/L)(meq/L)(meq/L)(meq/L)(meq/L)Pedialyte ®25* 45203530269Rehydralyte ®25 75206530305EquaLyte ®25 78.222.367.630.1337Enfalyte ®30**50254534170-200CeraLyte ®40**50-9020—30220-260Liquilytes ®25 45203530250dSentongo, T. A., “The Use of Oral Rehydration Solutions in Children and Adults,” Current Gastroenterology Reports, 6: 307-313, 2004.eKelly, D. G. et al., “Oral Rehydration Solution: A “Low-Tech” Oft Neglected Therapy,” Pract. Gastroenterol., 28: 51-62, 2004.*Includes 5 grams fructose.**Rice-based carbohydrates
Despite their effectiveness in maintaining and restoring hydration, the typical lack of palatability of ORS's can result in an undesirably low level of acceptance by patients and consumers. The high sodium content in particular results in an undesirable salty taste. Attempts to cover this salty taste typically have produced an ORS having a taste that is too sweet for many adult palates. It would be desirable to provide an ORS having an improved adult palatability. It would also be desirable to provide an ORS that could provide at least some of the health benefits of a fruit juice while still providing an effective hydration benefit.